The early complication rates of RP in our patients were slightly high compared to the Western series. By standardized report, being overweight, diabetes mellitus, and use of neoadjuvant hormone therapy were identified as predictors of early complications in our series.
For renal hilar tumor, RAPN could provide acceptable results of perioperative, pathological and renal function outcome as compared with non-hilar tumor group. Thus RAPN is a safe and effective nephron-sparing surgery technique for renal hilar tumors.
Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
One area of particular growth for robotic surgery has been partial nephrectomy. Despite a perceived notion that robotic‐assisted partial nephrectomy is more easily adaptable compared to laparoscopic partial nephrectomy, there is nonetheless an associated learning curve.
Validated training models with a corresponding assessment method for robotic‐assisted partial nephrectomy were previously unavailable. We have designed and validated a RAPN surgical model appropriate for resident and fellow training.
OBJECTIVE
To evaluate the face, content and construct validities of a novel ex vivo surgical training model for robotic‐assisted partial nephrectomy (RAPN).
METHODS
We prospectively identified participants as novice (not completed any robotic console cases), intermediate (at least one robotic console case but <100 cases), and expert (≥100 robotic console cases). Each participant performed a partial nephrectomy using the da Vinci Si Surgical System on an ex vivo porcine kidney with an embedded Styrofoam ball that mimics a renal tumour. Subjects completed a post‐study questionnaire assessing training model realism and utility. Participants were anonymously judged by three expert reviewers using a validated laparoscopic assessment tool. Performance between groups was compared using the tukey–kramer test.
RESULTS
The 46 participants recruited for this study included 24 novices, nine intermediates, and 13 experts. Overall, expert surgeons rated the training model as ‘very realistic’ (median visual analogue score 7/10) (face validity). Experts also rated the model as an ‘extremely useful’ training tool for residents (median 9/10) and fellows (9/10) (content validity), although less so for experienced robotic surgeons (5/10). Experts outscored novices on overall performance (P= 0.0002) as well as individual metrics, including ‘depth perception,’‘bimanual dexterity,’‘efficiency,’‘tissue handling,’‘autonomy,’‘precision,’ and ‘instrument and camera awareness’ (P < 0.05) (construct validity). Experts similarly outperformed intermediates in most metrics (P < 0.05).
CONCLUSION
Our novel ex vivo RAPN surgical model has demonstrated face, content and construct validity. Future development of this model should include simulation of haemostasis management and renal reconstruction.
Patients undergoing radical cystectomy after prior RP pose a challenge to urologists. Those who are continent post-RP have a fair chance of regaining good urinary control with neobladder reconstruction. Adjuvant radiotherapy for prostate cancer may have a negative impact on continence with neobladder reconstruction.
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